Healthcare Claims Data Analyst – Multi-Payer (NY Medicaid, Medicare, Commercial) - Contract to Hire
We are a New York–based Durable Medical Equipment (DME) provider seeking an experienced healthcare claims data analyst to generate multi-payer market intelligence.
Our focus includes:
NY Medicaid (Fee-for-Service)
NY Medicaid Managed Care (MMC)
Medicare Part B DMEPOS
Medicare Advantage
PPO / Commercial payers (where data is available)
Primary HCPCS focus: E0603 (breast pumps), with additional DME categories including orthotics, and maternity support.
This role is focused on legally accessing and analyzing claims datasets to build actionable referral and market intelligence.
Scope of Work
You will help us:
1️⃣ Identify & Access Appropriate Datasets
CMS Medicare Part B DMEPOS datasets (PUF, LDS, etc.)
Medicaid datasets (TAF, NY State data sources, or licensed vendor sources)
Medicaid Managed Care data (if available)
Medicare Advantage datasets
Commercial / PPO claims data sources (where accessible)
Ensure all access is compliant with data use agreements
2️⃣ Extract & Analyze Claims by HCPCS
Isolate claims tied to HCPCS codes (E0603 primary focus)
Segment by payer type:
Medicaid FFS
Medicaid Managed Care
Medicare
Medicare Advantage
Commercial / PPO
Aggregate utilization by NPI
Rank providers by volume
3️⃣ Market & Competitive Intelligence
Identify:
High-volume prescribing physicians by payer mix
Geographic concentration of DME orders (NY initial focus)
Providers serving high Medicaid or Managed Care populations
Market share by region and payer type
Competitors servicing those providers (where possible)
4️⃣ Sales Targeting Data Development
Build structured datasets for business development use, including:
Ranked provider lists by HCPCS and payer type
Payer-mix segmentation by provider
Geographic opportunity analysis
Specialty filtering (OB/GYN, PCP, etc.)
Deliver clean Excel/CSV outputs and optional dashboards (Power BI / Tableau preferred).
Deliverables
List of top prescribing physicians by HCPCS and payer type
NY geographic opportunity analysis (Medicaid, Medicare, Commercial segmented)
Competitive servicing breakdown (where data permits)
Market penetration summary report
Clean structured dataset including:
NPI
Total services
Payer breakdown
Geographic location
Required Expertise
Proven experience working with:
CMS datasets (PUF, LDS, CCW, etc.)
Medicaid claims data (TAF or state-level)
Medicare Advantage data structures
Commercial / PPO claims datasets (vendor-based or licensed sources)
DMEPOS billing structures
HCPCS coding (Level II)
NPI registry cross-referencing (NPPES)
Technical Requirements:
Advanced SQL
Python (pandas) or R (data.table / tidyverse)
Experience handling large healthcare claims datasets (millions of rows)
Data cleaning & normalization expertise
Understanding of healthcare data compliance and data use agreements
Strongly Preferred
DME industry analytics experience
NY Medicaid experience
Experience working with Medicaid Managed Care data
Familiarity with Medicare Advantage analytics
Experience building referral network mapping
Experience integrating multi-payer datasets into unified reporting
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